“Fox-Henhouse?” The Layers of Complexity Around MA Payment Discipline

Healthcare Innovation August 29, 2024
Mark Hagland

A KFF Health News report speaks to the challenges of Medicare Advantage payment rigor

So, this was interesting: KFF Health News is reporting that a plan initiated by CMS (the federal Centers for Medicare and Medicaid Services) has very quietly shelved a plan involving greater rigor around Medicare Advantage coding managemt.

This is what KFF Health News’s Fred Schulte wrote earlier this week: “A decade ago, federal officials drafted a plan to discourage Medicare Advantage health insurers from overcharging the government by billions of dollars — only to abruptly back off amid an ‘uproar’ from the industry, newly released court filings show. The Centers for Medicare & Medicaid Services published the draft regulation in January 2014. The rule would have...

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